CPT code 99152: Moderate sedation, same provider, age 5+, initial period2026 Medicare rate & RVUs in New York
Report initial moderate sedation for a patient age 5 or older when the procedure provider directs it with an independent trained observer.
Medicare pays $49.04–$60.78 for 99152 in the office in New York, from Rest of New York to NYC suburbs and Long Island, NY. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99152 covers
99152 covers moderate sedation directed by the physician or other qualified health care professional performing the underlying procedure for a patient age 5 or older. During a bronchoscopy, cardiac catheterization, transesophageal echocardiogram, or image-guided intervention, the proceduralist remains face-to-face with the patient while an independent trained observer, often a nurse, monitors consciousness and physiologic status. These services occur in catheterization labs, hospital procedure suites, and equipped offices.
Report 99152 once for the initial sedation period when at least 10 minutes of intraservice time are documented. Time begins when the sedating agent is administered and ends when the proceduralist’s continuous face-to-face attendance ends. Add 99153 at 23 minutes, with further units at 38 minutes and each subsequent 15-minute mark. Exclude preassessment and recovery from intraservice time; document agents, doses, the observer, monitoring, and start and stop times. For Medicare GI endoscopy with sedation directed by the endoscopist, report G0500 instead. The office practice-expense value reflects resources supplied by the practice rather than a facility.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99152 pays more and less in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
5 payment localities
$49.04 to $60.78
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | $59.38 | $12.41 |
| NYC suburbs and Long Island, NY | $60.78 | $12.73 |
| Poughkeepsie and northern NYC suburbs, NY | $56.02 | $11.77 |
| Queens, NY | $60.07 | $12.30 |
| Rest of New York | $49.04 | $10.64 |
How the 99152 rate is calculated
Each of 99152’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99152
RVUs × geographic indexes × conversion factor
Work0.25
0.25 RVUs× 1.000 GPCI
Practice expense1.26
1.26 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.5400
Conversion factor
$33.4009
Medicare rate
$51.44
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99152
99152 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99152
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$51.44
- Non-facility (office)
- $51.44
- Facility
- $11.02
Higher because the practice carries its own overhead.
99152 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99156Moderate sedationOther clinician, age 5+
- Use 99152 when the proceduralist directs sedation. Use 99156 when a separate physician or qualified health care professional provides it for a patient age 5 or older.
- 99151Moderate sedationSame proceduralist, under five
- Both describe initial sedation directed by the proceduralist. Use 99151 for patients younger than 5 and 99152 for patients age 5 or older.
- G0500Endoscopy sedationInitial 15 minutes, age 5+
- For Medicare GI endoscopy with endoscopist-directed sedation, report G0500 instead of 99152. Code 99152 can describe proceduralist-directed sedation for non-GI procedures such as bronchoscopy or cardiac catheterization.
- 99153Moderate sedationEach additional 15 minutes
- Report 99152 once for the initial sedation period. Add the first unit of 99153 when total intraservice time reaches 23 minutes.
99152 billing questions
What is the minimum time needed to report 99152?
At least 10 minutes of intraservice time is required. Sedation lasting under 10 minutes is not reported separately.
When is 99153 added?
Report one unit of 99153 when total intraservice time reaches 23 minutes. Additional units begin at 38 minutes, 53 minutes, and each subsequent 15-minute mark.
Can 99152 be billed if no independent observer is present?
No. This code requires a trained observer to monitor the patient while the proceduralist directs sedation and performs the procedure.
How does this differ from sedation provided by a separate clinician?
For a patient age 5 or older, a separate physician or qualified health care professional providing sedation reports 99156, adding 99157 only when the time warrants it. For a younger patient, the separate-provider initial code is 99155.
Should 99152 be used with a Medicare screening or diagnostic colonoscopy?
No. When the endoscopist provides moderate sedation for Medicare GI endoscopy to a patient age 5 or older, report G0500 instead of 99152.
Does the presedation evaluation count toward sedation time?
No. Presedation assessment, consent, and recovery monitoring after the proceduralist’s face-to-face attendance ends are excluded from intraservice time.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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